Implementation Guide for Transmission of

Laboratory, Pharmacy and Supply Orders

as Public Health Information using

Version 2.3.1 of the

Health Level Seven (HL7) Standard Protocol

Updated: May 27, 2003

Centers for Disease Control and Prevention

Implementation Guide Laboratory, Pharmacy and Supply Orders HL7 v2.3.1

Table of Contents
TABLE OF CONTENTS ............................................................................................................................. 2

REVISION HISTORY................................................................................................................................. 4

CREDITS ...................................................................................................................................................... 4

INTRODUCTION ........................................................................................................................................ 4

SCOPE........................................................................................................................................................... 5

DEFINITIONS.............................................................................................................................................. 5

CONVENTIONS .......................................................................................................................................... 6
MESSAGE SEGMENT STRUCTURE................................................................................................................ 6
MESSAGE SCHEMA ..................................................................................................................................... 6
MESSAGE EXAMPLE ................................................................................................................................... 6
SEGMENT DEFINITIONS .............................................................................................................................. 7
Segment Attribute Table Header Definitions .................................................................................................... 7
USE CASES .................................................................................................................................................. 8
CLINICAL SCENARIO................................................................................................................................... 8
DIAGNOSTIC TESTING ................................................................................................................................. 9
Message Segment Structure .................................................................................................................. 9
Message Schema ................................................................................................................................... 9
Message Example................................................................................................................................ 10
PHARMACY............................................................................................................................................... 10
Message Segment Structure ................................................................................................................ 11
Message Schema ................................................................................................................................. 12
Message Example................................................................................................................................ 12
SUPPLY ..................................................................................................................................................... 13
Message Segment Structure ................................................................................................................ 13
Message Schema ................................................................................................................................. 13
Message Example................................................................................................................................ 14
SEGMENT DEFINITIONS....................................................................................................................... 14
MSH SEGMENT – MESSAGE HEADER ....................................................................................................... 15
MSH – Message Header Segment attributes ................................................................................................... 15
MSH field definitions .......................................................................................................................... 16
MSH-4 Sending facility (HD) 00004 ............................................................................................................ 16
PID SEGMENT - PATIENT IDENTIFICATION ............................................................................................... 16
AL1 SEGMENT – ALLERGY INFORMATION ............................................................................................... 17
AL1 – Allergy Information Segment attributes............................................................................................... 17
AL1 field definitions............................................................................................................................ 17
AL1-2 Allergy Type (IS) 00204................................................................................................................ 17
AL1-3 Allergy code/mnemonic/description (CE) 00205...................................................................... 17
ORC SEGMENT – COMMON ORDER .......................................................................................................... 17
RQD - REQUISITION DETAIL SEGMENT .................................................................................................... 18
RQD – Requisition Detail Segment attributes................................................................................................. 18
RQD field definitions .......................................................................................................................... 18
RQD-3 Item code - external (CE) 00277 .................................................................................................... 18
RQD-7 Dept. cost center (IS) 00281 ........................................................................................................... 18
RXO - PHARMACY/TREATMENT ORDER SEGMENT .................................................................................... 19
RXO – Pharmacy/treatment Order Segment attributes.................................................................................... 19
RXO field definitions........................................................................................................................... 20

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RXO-1 Requested give code (CE) 00292.................................................................................................... 20

RXO-2 Requested give amount - minimum (NM) 00293 ........................................................................... 20
RXO-3 Requested give amount - maximum (NM) 00294........................................................................... 21
RXO-4 Requested give units (CE) 00295 ................................................................................................... 21
RXO-5 Requested dosage form (CE) 00296 ............................................................................................... 21
RXE - PHARMACY/TREATMENT ENCODED ORDER SEGMENT..................................................................... 21
RXE field definitions ........................................................................................................................... 23
RXE-1 Requested give code (CE) 00292 .................................................................................................... 23
RXE-2 Requested give amount - minimum (NM) 00293............................................................................ 23
RXE-3 Requested give amount - maximum (NM) 00294 ........................................................................... 23
RXE-4 Requested give units (CE) 00295.................................................................................................... 23
RXE-5 Requested dosage form (CE) 00296................................................................................................ 24
APPENDIX A – MEMBERS OF THE CDC EHEALTH INITIATIVE PUBLIC PRIVATE
COLLABORATION WORKING GROUP ON ORDERS..................................................................... 25

APPENDIX B – TABLES .......................................................................................................................... 26

User-defined Table 0127 – Allergy Type........................................................................................................ 26
HL7 Table 0038 - Order status........................................................................................................................ 26
HL7 Table 0074 - Diagnostic service section ID ............................................................................................ 26
HL7 Table 0123 - Result status....................................................................................................................... 27
HL7 Table 0085 - Observation result status codes interpretation.................................................................... 28

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Revision History

Date Author Comments

30-Oct-02 J. Marc Overhage Initial draft

1-Mar-03 J. Marc Overhage Extensive revision based on

feedback from reviewers

5-May-03 Scott Robertson Editorial revision for internal

consistency and integrity
check against HL7 v2.3.1.

27-May-03 Scott Robertson Final editorial changes to

move document out of “draft”
status

Credits
A working group (members are listed in the Appendix) convened by the CDC and
eHealth Foundation’s Public Private Collaboration created materials that formed the basis
for this implementation guide.

Introduction
There is a strong logical link between a clinician’s notions of what is wrong with a
patient and what is ordered to care for that patient. Even before results of test are
available, orders for them are often recorded in electronic systems. Other aspects of
medical care such as ventilator management might be determined or inferred from other
orders such as those for supplies or ancillary services. Because orders are one of the
earliest electronically available sources of information about episodes of medical care,
they may be a useful source of information for detecting the onset, increase, or spread of
a public health problem. For example:

Presentation or Preliminary Assessment Characteristic Orders

Gastroenteritis stool culture, stool O&P, stool for Norwalk virus or

rotavirus detection.
Influenza-like illness direct test for influenza, influenza culture, acute serum for
antibodies to respiratory viruses, chest X-ray
Lower respiratory illness sputum culture, blood culture, chest X-ray, arterial blood

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gasses, intubation
CNS infection lumbar puncture, CSF culture, blood culture

More specificity might be gained by combining orders, like chest X-ray PLUS sputum
culture, or by imposing age restrictions.

Scope
This guide does not stand alone – it should be read in conjunction with CDC’s
“Implementation Guide for Transmission of Laboratory-Based Reporting of Public
Health Reporting Information using Version 2.3.1 of the Health Level Seven (HL7)
Standard Protocol” and the HL7 Version 2.3.1 standard.

This guide focuses on diagnostic test or clinical observation orders, supplies and
pharmacy orders. Test orders could include a broad spectrum of diagnostic testing and
clinical observations such as vital signs, electrocardiograms, cultures and serology
depending on the institution’s processes. Which supplies are represented in messsages
will also be highly dependent on local processes.

In addition to surveillance applications of orders, public health may need to monitor use
of specific antibiotics or other medications used in either the inpatient or outpatient
setting. These applications may require more details about the order and the medication
administration process than surveillance. Tracking the administration of aspirin after
recognition of acute myocardial infarction in the inpatient setting for example, requires
messages that contain not only ordering but administration data. These uses are out of
scope for the current version of this implementation guide. HL7 is the NEDSS messaging
standard so this guide focuses exclusively on HL7 order messages. However, the NCPDP
standard is used for a large volume of outpatient prescription messaging.

Public health officials will specify which orders are needed for specific public health
purposes using LOINC codes, NDC (and later RxNORM) codes or ECRI UMDNS codes.
Orders that are not associated with a specific patient such as orders for supplies to
replenish unit or floor stock should not be sent to public health.

Definitions
Filler: (also Performer) the application responding to, i.e., performing, a request for
services (orders) or producing an observation. The filler can also originate requests for
services (new orders), add additional services to existing orders, replace existing orders,
put an order on hold, discontinue an order, release a held order, or cancel existing orders.

Order: a request for a service from one application to a second application. The second
application may in some cases be the same; i.e., an application is allowed to place orders
with itself.

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Order detail segment: one of several segments that can carry order information.
Examples are OBR and RXO. Future ancillary-specific segments may be defined in
subsequent releases of the Standard if they become necessary.

Placer: (also Requestor) the application or individual originating a request for services
(order).

Placer order group: a list of associated orders coming from a single location regarding a
single patient.

Conventions
In order to provide concrete guidance, each message use case will be presented in three
versions: as a message segment structure, message schema and message example.

Message Segment Structure

Also known as the HL7 Abstract Message Syntax. This format specifies the order of
HL7 segments and segment groups, whether they are optional or mandatory, and whether
or not they repeat. It does not include detailed information about the data elements
within the segments. It illustrates the overall structure of the message.

Message Schema
This format describes how data elements within segments are valued, typically using
generic terms (e.g. date of birth, medical record number). It illustrates the content of the
message.

Message Example
This format provides a concrete example of individual data elements within the segments
of a message. It illustrates the formatting of individual data elements.

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Generic Order Message

Generic order message

MSH message header

PID patient identification

[ PV1 ] Patient visit information

[{ AL1 }] Allergy Information

{ --- Order Begin

ORC order control

Order detail segment(s)

OBR | Observation request, or
RDQ | Requistion Detail, or
RXO | Pharmacy Order Request, or
RXE Pharmacy Encoded Order

[{ NTE }] notes and comments

{ --- Observation Begin

[ OBX ] Observation

[{ NTE }] notes and comments

} --- Observation End

} --- Order End

The generic order message in the table above represents a superset of all order messages.
It supports the several use cases including orders for

• diagnostic tests,
• medications, and
• supplies.

Segment Definitions
The Segment Attribute Table summarizes the field content of a specified segment. The
column headers for the Segment Attribute Table are described as follows:

Segment Attribute Table Header Definitions

Header Text Description

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Header Text Description

SEQ The sequence of the elements as they are numbered in the segment.
LEN The length of the element.
DT The data type of the element.
OPT Whether the field is required, optional, or conditional in a segment as defined by HL7 2.3.1.
These do not refer to requirements for reporting in the context of this guide. The designations
are:
R Required.
O Optional.
C Conditional on the trigger event or on some other field(s). The field definitions
following the segment attribute table should specify the algorithm that defines the
conditionality for the field.
X Not used with this trigger event.
B Left in for backward compatibility with previous versions of HL7. The field
definitions following the segment attribute table should denote the optionality of the
field for prior versions.
RP/# Indicates if element repeats. IF the number of repetitions is limited, the number of allowed
repetitions is given.
TBL# Specific table reference. Tables defined in HL7 v2.3.1 and used in this guide are listed in
Appendix B.
ITEM# HL7 unique item number for each element.
Element Name Descriptive name of element in the segment.
OPT for ELR Whether the field is required or ignored specifically in the context of this guide. The
designations are:
R Required.
I Ignored.
IMPLEMENTATION Addition comments related to the use of the field in the context of this guide.
COMMENTS

The field definitions following the Segment Attribute Table serve to clarify, extend or
constrain the meaning or intent of the field in the context of this guide. Not all fields
present in a segment will have accompanying narrative.

Use Cases
Clinical Scenario
In order to provide consistent examples, this guide uses the following common clinical
scenario: Michael Able presents at the emergency department at MyHospital with
symptoms of cough, fever and malaise. Dr M J Welby evaluates the patient and orders a
chest radiograph. Based on symptoms and the radiographic findings, Dr Welby
prescribes an initial dose of ciprofloxicin intravenously. The patient deteriorates and
requires tracheal intubation and mechanical ventilation. The respiratory therapist in the
emergency department records an order for a “ventilator” and “endotracheal tube #8” that
will allow MyHospital to generate a charge for the ventilator setup.

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Diagnostic testing
When a provider orders a diagnostic test, even without a provider order entry system,
there is usually an electronic order generated either in an institutional order management
system (entered by a clerk for example) or by the laboratory information system (entered
by laboratory personnel). This order may be available a long time before the actual result
for certain tests. For example, results from some cultures may require days to weeks to
become available. Diagnostic test orders may also provide information that diagnostic
tests have been ordered for which results are not electronically available. An order for a
chest radiograph in an environment without electronic access to radiology reports, for
example. Even in environments with a sophisticated radiology information system,
results may be delayed for days.

Message Segment Structure

ORM^O01^ORM_O01 General Order Message Chapter

MSH Message Header 2

PID Patient Identification 3

[{ AL1 }] Allergy Information 3

ORC Order Control 4

OBR Observation request 4

The General Order Message segment structure, above, is a subset of the ORM_O01
structure defined in HL7 v2.3.1 Chapter 4. This subset constitutes the minimum
necessary message structure to communicate an order for a diagnostic test in the context
of this Implementation Guide. Additional segments, as defined in HL7 v2.3.1, may be
present in the message, but are not required and are not detailed in this Implementation
Guide.

Message Schema
MSH|^~\&| sending application | sending facility |
receiving application ||||ORM^O01^ORM_O01| message
control id |P|2.3.1…<cr>
PID||| patient ids || patient name …<cr>
[{ AL1| set id | allergy type | allergen …<cr> }]
ORC| order control code | requestor’s order number |
processor’s order number ||||| transaction date-time |
enterer Id || ordering provider ID | enterer's location
…<cr>

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OBR| set id | requestor’s order number | processor’s order

number | test ordered ||| observation date-time …<cr>

Message Example
The following message example represents the initial order in the clinical scenario
presented above. Specifically, a new order by Dr M J Welby (entered by ward clerk
Mary Gilbert) in the ER at MyHospital for a Portable Chest X-ray of Michael Able. In
this case there are no allergies communicated and only the requestor's order number is
available. Since this is a new order is being sent from the order management system to
the radiology system, no processor order number has been assigned.
MSH|^~\&|MyHospital|MyHospital^543876^CMS|LocalRadiology|||
|ORM^O01^ORM_O01|00001|P|2.3.1<cr>
PID|||1234321^^^MyHospital^MR||Able^Michael^D^^^^L<cr>
ORC|NW|0889436^MyHospital||||||20011001081234|A99887^Gilber
t^Mary^^^^^MyHospital||1234567^Welby^M^J^Jr^Dr^^MyHospit
al|ER<cr>
OBR|1|0889436^MyHospital||24632-2^Portable Chest^LN<cr>

Pharmacy
When a provider orders a medication, even without a provider order entry system, there is
usually an electronic order generated either in an institutional order management system
(entered by a clerk for example) or by the pharmacy system (entered by pharmacy
personnel). Depending on the details of the environment, there may or may not be
subsequent messages indicating dispensing, administration and other activity related to
this order.

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Message Segment Structure

ORM^O01^RDO_O01 Pharmacy/Treatment Order Message Chapter

MSH Message Header 2

PID Patient Identification 3

[{ AL1 }] Allergy Information 3

ORC Order Control 4

RXO Pharmacy/Treatment Order 4

{ RXR } Pharmacy/Treatment Route 4

RDE^O01^RDE_R01 Pharmacy/Treatment Encoded Order Chapter

Message

MSH Message Header 2

PID Patient Identification 3

[{ AL1 }] Allergy Information 3

ORC Order Control 4

RXE Pharmacy/Treatment Encoded Order 4

{ RXR } Pharmacy/Treatment Route 4

The Pharmacy/Treatment Order Message and Pharmacy/Treatment Encoded Order

Message segment structures, above, are subsets of the RDO_O01 and RDE_O01
structures defined in HL7 v2.3.1 Chapter 4. These subsets constitute the minimum
necessary message structure to communicate a pharmacy order in the context of this
Implementation Guide. Additional segments, as defined in HL7 v2.3.1, may be present
in the message, but are not required and are not detailed in this Implementation Guide.

Two message structures are presented as HL7 v2.3.1 defines distinct messages depending
on message origination. A hospital order entry system, acting as a Placer, would send an
ORM message to the pharmacy system, acting as the Filler. The pharmacy system would
send an RDE message to a hospital order entry system. The content is similar in both
messages, however the ORM message reports the prescriber's request, while the RDE
message reports what how the pharmacy has interpreted the order. The content of the
request is sufficiently different from the content of the interpretation that HL7 v2.3.1
provides these different messages (ORM versus RDE), structures (RDO_O01 versus
RDE_O01) and target segments (RXO versus RXE).

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Message Schema
MSH|^~\&| sending application | sending facility |
receiving application ||||ORM^O01^RDO_O01| message
control id |P|2.3.1…<cr>
PID||| patient ids || patient name …<cr>
[{ AL1| set id | allergy type | allergen …<cr> }]
ORC| order control code | requestor’s order number |
processor’s order number ||||| transaction date-time |
enterer Id || ordering provider ID | enterer's location
…<cr>
RXO| quantity/timing | medication code | amount to be given ||
give amount units | dosage form …<cr>
RXR| route of administration …<cr>

MSH|^~\&| sending application | sending facility |

receiving application ||||RDE^O01^RDE_O01| message
control id |P|2.3.1…<cr>
PID||| patient ids || patient name …<cr>
[{ AL1| set id | allergy type | allergen …<cr> }]
ORC| order control code | requestor’s order number |
processor’s order number ||||| transaction date-time |
enterer Id || ordering provider ID | enterer's location
…<cr>
RXE| quantity/timing | medication code | amount to be given ||
give amount units …<cr>
RXR| route of administration …<cr>

Message Example
The following message example represents the order for ciprofloxacin in the clinical
scenario presented above. Specifically, a new order by Dr M J Welby, Jr (entered by
ward clerk Mary Gilbert) in the ER at MyHospital for a single intravenous dose of
ciprofloxacin 200mg to be administered to Michael Able. This message also contains
information that the patient is allergic to penicillins. Since this is a new order is being
sent from the order management system to the pharmacy system, the pharmacy order
number has yet to be assigned.
MSH|^~\&|MyHospital|MyHospital^543876^CMS|LocalPharmacy||||
ORM^O01^RDO_O01|00015|P|2.3.1<cr>

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PID|||1234321^^^MyHospital^MR||Able^Michael^D^^^^L<cr>
AL1|1|DA|^Penicillin<cr>
ORC|NW|0889475^MyHospital||||||20011001084135|A99887^Gilber
t^Mary^^^^^MyHospital||1234567^Welby^M^J^Jr^Dr^^MyHospit
al|ER<cr>
RXO|1^Once|0026-8562^Ciprofloxicin
Inj^NDC|200||mg^milligram^ISO+|^Injection …<cr>
RXR|IV^Intravenous^HL70162<cr>

Supply
Even in environments with provider order entry, the only indication that certain
treatments or diagnostic tests are being used may come from orders for supplies that are
generated primarily for charge capture. A clerk, technician or nursing personnel will
often enter these orders.

Message Segment Structure

ORM^O01^OMS_O01 Stock Requisition Order Message Chapter

MSH Message Header 2

PID Patient Identification 3

[{ AL1 }] Allergy Information 3

ORC Order Control 4

RQD Requisition Detail 4

The Stock Requisition Order Message segment structure, above, is a subset of the
OMS_O01 structure defined in HL7 v2.3.1 Chapter 4. This subset constitutes the
minimum necessary message structure to communicate a supply order in the context of
this Implementation Guide. Additional segments, as defined in HL7 v2.3.1, may be
present in the message, but are not required and are not detailed in this Implementation
Guide.

Message Schema
MSH|^~\&| sending application | sending facility |
receiving application ||||ORM^O01^OMS_O01| message
control id |P|2.3.1…<cr>
PID||| patient ids || patient name …<cr>
[{ AL1| set id | allergy type | allergen …<cr> }]

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ORC| order control code | requestor’s order number |

processor’s order number ||||| transaction date-time |
enterer Id || ordering provider ID | enterer's location
…<cr>
RQD| requisition line number | ordered item ||| order
quantity | order unit of measure …<cr>

Message Example
The following message example represents the order for ventilator setup in the clinical
scenario presented above. Specifically, a new order by Dr M J Welby, Jr (entered by
respiratory therapist Martin James) in the ER at MyHospital for a ventilator and
endotrachial tube #8, to be used in therpeutic management of Michael Able. Since this is
a new order is being sent from the order management system to the materials
management system, the materials management order number has yet to be assigned.
MSH|^~\&|MyHospital|MyHospital^543876^CMS|LocalPharmacy||||
ORM^O01^RDO_O01|00015|P|2.3.1<cr>
PID|||1234321^^^MyHospital^MR||Able^Michael^D^^^^L<cr>
AL1|1|DA|^Penicillin<cr>
ORC|NW|0889587^MyHospital||||||2001100114505|R32412^James^M
artin^^^^^MyHospital||1234567^Welby^M^J^Jr^Dr^^MyHospita
l|ER<cr>
RQD|1|10-053^endotracheal tube #8^UMD|||1|UT^unit^L|
ORC|NW|0889588^MyHospital||||||2001100114505|R32412^James^M
artin^^^^^MyHospital||1234567^Welby^M^J^Jr^Dr^^MyHospita
l|ER<cr>
RQD|2|15-613^ventilator cirucuit^UMD|||1|UT^unit^L|

Segment Definitions
The HL7 General Order Message (ORM) is the starting point. Unneeded contents were
pared away to form the recommended message. The format includes minimal segments:

MSH --Message Header

PID -- Patient Identification

[AL1] – Allergy

ORC -- Common Order

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OBR -- Observation Request

RQD -- Requisition Detail

RXO -- Pharmacy/Treatment Order

RXE -- Pharmacy/Treatment Encoded Order

MSH Segment – Message Header

See Implementation Guide for Transmission of Laboratory-Based Reporting of Public
Health Reporting Information using Version 2.3.1 of the Health Level Seven (HL7)
Standard Protocol for additional discussion of this segment.

MSH – Message Header Segment attributes

SEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT OPT IMPLEMENTATION
NAME for COMMENTS
ELR

1 1 ST R 00001 Field
separator

2 4 ST R 00002 Encoding
characters

3 180 HD O 00003 Sending

application

4 180 HD O 00004 Sending

facility

5 180 HD O 00005 Receiving

application

6 180 HD O 00006 Receiving

facility

7 26 TS O 00007 Date/Time of
message

8 40 ST O 00008 Security

9 7 CM R 0076 / 00009 Message

0003 type

10 20 ST R 00010 Message
control ID

11 3 PT R 00011 Processing
ID

12 60 VID R 0104 00012 Version ID

13 15 NM O 00013 Sequence
number

14 180 ST O 00014 Continuation

pointer

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SEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT OPT IMPLEMENTATION

NAME for COMMENTS
ELR

15 2 ID O 0155 00015 Accept

acknowledgm
ent type

16 2 ID O 0155 00016 Application

acknowledgm
ent type

17 2 ID O 00017 Country code

18 10 ID O Y 0211 00692 Character set

19 60 CE O 00693 Principal
language of
message

20 20 ID O 0356 01317 Alternate

character set
handling
scheme

MSH field definitions

MSH-4 Sending facility (HD) 00004

Components: <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID

type ID>

Definition: In order to clearly identify the sending institution, the sending facility
field should be constructed as follows: The sending institution will use the CMS
Provider of Services (POS) code (available for download at
http://www.cms.hhs.gov/data/download/default.asp) to identify itself in this field.
They should include the text name of the institution, followed by the unique CMS
Provider of service identifier and finally, the identifier type “CMS”. For example:
MSH|^~\&||MyHospital^543876^CMS|…<cr>

If the CMS identifier is for a multifacility or multiple location entity, append an

integer identifier to the CMS POS code using a decimal to separate them. For
example
MSH|^~\&||MyFirstHospital^543876.1^CMS|…<cr>

PID Segment - Patient Identification

See Implementation Guide for Transmission of Laboratory-Based Reporting of Public
Health Reporting Information using Version 2.3.1 of the Health Level Seven (HL7)
Standard Protocol for a discussion of this segment.

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AL1 Segment – Allergy Information

The AL1 segment contains patient allergy information of various types. Most of this
information will be derived from user-defined tables. Each AL1 segment describes a
single patient allergy.

AL1 – Allergy Information Segment attributes

SEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT OPT IMPLEMENTATION
NAME for COMMENTS
ELR

1 4 SI R 00203 Set ID - AL1 R

2 2 IS O 0127 00204 Allergy Type I

3 60 CE R 00205 Allergy R Only allergies with

Code/Mnemo coded values in this
nic/Descriptio field will be stored
n and any text entries
sent will be ignored

4 2 IS O 0128 00206 Allergy I

Severity

5 15 ST O Y 00207 Allergy I
Reaction

6 8 DT O 00208 Identification I
Date

AL1 field definitions

AL1-2 Allergy Type (IS) 00204

Definition: This field identifies the type of allergy being reported. Refer to User-
defined Table 0127 – Allergy Type for suggested values.

AL1-3 Allergy code/mnemonic/description (CE) 00205

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field identifies the agent the patient has an allergy to. For drugs,
the agent should be identified using the NDC coding system to be replaced by
RxNorm when available. For other agents, free text may be used but public
health systems may not store uncoded results.

ORC Segment – Common Order

See Implementation Guide for Transmission of Laboratory-Based Reporting of Public
Health Reporting Information using Version 2.3.1 of the Health Level Seven (HL7)
Standard Protocol for a discussion of this segment.

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RQD - Requisition Detail Segment

RQD contains the detail for each requisitioned item. See assumptions above.

RQD – Requisition Detail Segment attributes

SEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT OPT IMPLEMENTATION
NAME for COMMENTS
ELR

1 4 SI O 00275 Requisition I
Line Number

2 60 CE O 00276 Item Code - I

Internal

3 60 CE R 00277 Item Code - R The external item

External code represented
using the ECRI
UMDNS code is the
essential data in this
segment.

4 60 CE O 00278 Hospital Item I

Code

5 6 NM O 00279 Requisition I
Quantity

6 60 CE O 00280 Requisition I
Unit of
Measure

7 30 IS O 0319 00281 Dept. Cost O

Center

8 30 IS O 0320 00282 Item Natural I

Account
Code

9 60 CE O 00283 Deliver To ID I

10 8 DT O 00284 Date Needed I

RQD field definitions

RQD-3 Item code - external (CE) 00277

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field contains the ECRI UMDNS code the supply being ordered.

RQD-7 Dept. cost center (IS) 00281

Definition: This field contains the code from user-defined table 0319 -
Department cost center that identifies the department that the supply being

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 Implementation Guide Laboratory, Pharmacy and Supply Orders HL7 v2.3.1

ordered is linked to in the sending institution. These linkages may be different in

different institutions.

RXO - pharmacy/treatment order segment

This is the “master” pharmacy/treatment order segment. It contains order data not
specific to components or additives. Unlike the OBR, it does not contain status fields or
other data that are results-only.

It can be used for any type of pharmacy order, including inpatient (unit dose and
compound unit dose), outpatient, IVs, and hyperalimentation IVs (nutritional IVs), as
well as other non-pharmacy treatments, e.g., respiratory therapy, oxygen, and
metabolites.

RXO – Pharmacy/treatment Order Segment attributes

SEQ LEN DT OPT RP/# TBL ITEM ELEMENT NAME OPT Implementation
# # For Comments
ELR

1 100 CE R 00292 Requested Give Code R

2 20 NM R 00293 Requested Give Amount - R

Minimum

3 20 NM O 00294 Requested Give Amount - R

Maximum

4 60 CE R 00295 Requested Give Units R

5 60 CE O 00296 Requested Dosage Form R

6 200 CE O Y 00297 Provider’s I

Pharmacy/Treatment
Instructions

7 200 CE O Y 00298 Provider’s Administration I

Instructions

8 200 CM O 00299 Deliver-To Location I

9 1 ID O 0161 00300 Allow Substitutions I

10 100 CE O 00301 Requested Dispense Code I

11 20 NM O 00302 Requested Dispense Amount I

12 60 CE O 00303 Requested Dispense Units I

13 3 NM O 00304 Number Of Refills I

14 60 XCN C Y 00305 Ordering Provider’s DEA I

Number

15 60 XCN C Y 00306 Pharmacist/Treatment I

Supplier’s Verifier ID

16 1 ID O 0136 00307 Needs Human Review I

17 20 ST C 00308 Requested Give Per (Time I

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 Implementation Guide Laboratory, Pharmacy and Supply Orders HL7 v2.3.1

SEQ LEN DT OPT RP/# TBL ITEM ELEMENT NAME OPT Implementation
# # For Comments
ELR
Unit)

18 20 NM O 01121 Requested Give Strength I

19 60 CE O 01122 Requested Give Strength I

Units

20 200 CE O Y 01123 Indication I

21 6 ST O 01218 Requested Give Rate Amount I

22 60 CE O 01219 Requested Give Rate Units I

23 10 CQ O 00329 Total Daily Dose I

RXO field definitions

RXO-1 Requested give code (CE) 00292

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field identifies the medical substance or product ordered to be

given to the patient; it is equivalent to OBR-4-universal service ID in function.
The request-to-dispense fields, which define the type and amount of what is to be
issued to the patient (see RXO-10 requested dispense code, RXO-11-requested
dispense amount, and RXO-12-requested dispense units), do not necessarily
correlate with the instructions of what amount is to be “given” or administered
with each dose, and may or may not be specified with the order. For example, the
“give” part of the order may convey the field-representation of give 15 mg of
Librium every 6 hours, while the request to dispense part of the order may convey
issue 30 tablets of 10 mg generic equivalent for this outpatient prescription.
When the give code does not include the dosage form, use RXO-5-requested
dosage form. The requested give code should be provided as an NDC (National
Drug Code) with the NDC code, the name of the drug and the coding system
specified. When RxNorm codes become available, they should be used instead,
again specifying the code, text name and coding system.

RXO-2 Requested give amount - minimum (NM) 00293

Definition: This field is the ordered amount. In a variable dose order, this is the
minimum ordered amount. In an order in which a specific dose is specified, this
is the exact amount of the order.

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 Implementation Guide Laboratory, Pharmacy and Supply Orders HL7 v2.3.1

RXO-3 Requested give amount - maximum (NM) 00294

Definition: In a variable dose order, this is the maximum ordered amount. In an

order in which a specific dose is specified, this field is not used.

RXO-4 Requested give units (CE) 00295

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field indicates the units for the give amount. Units should follow the
HL7 Version 2.3.1 convention specified in Chapter 7.

RXO-5 Requested dosage form (CE) 00296

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field indicates the manner in which the medication is aggregated
for dispensing, e.g., tablets, capsules, suppositories. In some cases, this
information is implied by the dispense/give code in RXO-1-requested give code or
RXO-10-requested dispense code. Use when both RXO-1-requested give code
and RXO-10-requested dispense code do not specify the drug/treatment form.

RXE - pharmacy/treatment encoded order segment

The RXE segment details the pharmacy or treatment application’s encoding of the order.
It also contains several pharmacy-specific order status fields, such as RXE-16-number of
refills remaining, RXE-17-number of refills/doses dispensed, RXE-18-D/T of most recent
refill or dose dispensed, and RXE-19-total daily dose.

Note that ORC-7-quantity/timing has a different meaning from RXE-1-quantity/timing

and RXG-3-quantity/timing. The pharmacy or treatment department has the “authority”
(and/or necessity) to schedule dispense/give events. Hence, the pharmacy or treatment
department has the responsibility to encode this scheduling information in RXE-1-
quantity/timing and RXG-3-quantity/timing. ORC-7-quantity/timing does not change: it
always specifies the requested give/dispense schedule of the original order.

RXE – Pharmacy/treatment Encoded Order Segment attributes

SEQ LEN DT OPT RP/# TBL ITEM ELEMENT NAME OPT Implementation
# # For Comments
ELR

1 200 TQ R 00221 Quantity/Timing I

2 100 CE R 0292 00317 Give Code R

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SEQ LEN DT OPT RP/# TBL ITEM ELEMENT NAME OPT Implementation
# # For Comments
ELR

3 20 NM R 00318 Give Amount – Minimum R

4 20 NM O 00319 Give Amount - Maximum R

5 60 CE R 00320 Give Units R

6 60 CE O 00321 Give Dosage Form R

7 200 CE O Y 00298 Provider’s Administration I

Instructions

8 200 CM C 00299 Deliver-to Location I

9 1 ID O 0167 00322 Substitution Status I

10 20 NM C 00323 Dispense Amount I

11 60 CE C 00324 Dispense Units I

12 3 NM O 00304 Number of Refills I

13 60 XCN C Y 00305 Ordering Provider’s DEA I

Number

14 60 XCN O Y 00306 Pharmacist/Treatment I

Supplier’s Verifier ID

15 20 ST C 00325 Prescription Number I

16 20 NM C 00326 Number of Refills Remaining I

17 20 NM C 00327 Number of Refills/Doses I

Dispensed

18 26 TS C 00328 D/T of Most Recent Refill or I

Dose Dispensed

19 10 CQ C 00329 Total Daily Dose I

20 1 ID O 0136 00307 Needs Human Review I

21 200 CE O Y 00330 Pharmacy/Treatment Supplier’s I

Special Dispensing Instructions

22 20 ST C 00331 Give Per (Time Unit) I

23 6 ST O 00332 Give Rate Amount I

24 60 CE O 00333 Give Rate Units I

25 20 NM O 01126 Give Strength I

26 60 CE O 01127 Give Strength Units I

27 200 CE O Y 01128 Give Indication I

28 20 NM O 01220 Dispense Package Size I

29 60 CE O 01221 Dispense Package Size Unit I

30 2 ID O 0321 01222 Dispense Package Method I

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RXE field definitions

RXE-1 Requested give code (CE) 00292

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field identifies the medical substance or product ordered to be

given to the patient; it is equivalent to OBR-4-universal service ID in function.
The request-to-dispense fields, which define the type and amount of what is to be
issued to the patient (see RXO-10 requested dispense code, RXO-11-requested
dispense amount, and RXO-12-requested dispense units), do not necessarily
correlate with the instructions of what amount is to be “given” or administered
with each dose, and may or may not be specified with the order. For example, the
“give” part of the order may convey the field-representation of give 15 mg of
Librium every 6 hours, while the request to dispense part of the order may convey
issue 30 tablets of 10 mg generic equivalent for this outpatient prescription.
When the give code does not include the dosage form, use RXO-5-requested
dosage form. The requested give code should be provided as an NDC (National
Drug Code) with the NDC code, the name of the drug and the coding system
specified. When RxNorm codes become available, they should be used instead,
again specifying the code, text name and coding system.

RXE-2 Requested give amount - minimum (NM) 00293

Definition: This field is the ordered amount. In a variable dose order, this is the
minimum ordered amount. In an order in which a specific dose is specified, this
is the exact amount of the order.

RXE-3 Requested give amount - maximum (NM) 00294

Definition: In a variable dose order, this is the maximum ordered amount. In an

order in which a specific dose is specified, this field is not used.

RXE-4 Requested give units (CE) 00295

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field indicates the units for the give amount. Units should follow the
HL7 Version 2.3.1 convention specified in Chapter 7.

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RXE-5 Requested dosage form (CE) 00296

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^

<alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of
alternate coding system (ST)>

Definition: This field indicates the manner in which the medication is aggregated
for dispensing, e.g., tablets, capsules, suppositories. In some cases, this
information is implied by the dispense/give code in RXO-1-requested give code or
RXO-10-requested dispense code. Use when both RXO-1-requested give code
and RXO-10-requested dispense code do not specify the drug/treatment form.

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Appendix A – Members of the CDC eHealth Initiative

Public Private Collaboration Working Group on Orders
• Raymond Aller, 4Medica

• Camilla Couderc, Siemens

• David Edelstein, 4Medica

• Bill Hogan, University of Pittsburgh

• Richard Hopkins, SAIC

• Theresa Horan, CDC

• Dan Jernigan, CDC

• J. Marc Overhage, Regenstrief Institute, Indiana University School of Medicine

• Karen Sieber, Cerner

• Helen Stevens, McKesson

• Mead Walker, CDC

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Implementation Guide Laboratory, Pharmacy and Supply Orders HL7 v2.3.1

Appendix B – Tables
User-defined Table 0127 – Allergy Type
Value Description

DA Drug allergy

FA Food allergy

MA Miscellaneous allergy

MC Miscellaneous contraindication

HL7 Table 0038 - Order status

Value Description

A Some, but not all, results available

CA Order was canceled

CM Order is completed

DC Order was discontinued

ER Error, order not found

HD Order is on hold

IP In process, unspecified

RP Order has been replaced

SC In process, scheduled

HL7 Table 0074 - Diagnostic service section ID

Value Description

AU Audiology

BG Blood gases

BLB Blood bank

CUS Cardiac Ultrasound

CTH Cardiac catheterization

CT CAT scan

CH Chemistry

CP Cytopathology

EC Electrocardiac (e.g., EKG, EEC, Holter)

EN Electroneuro (EEG, EMG,EP,PSG)

HM Hematology

ICU Bedside ICU Monitoring

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Value Description

IMG Diagnostic Imaging

IMM Immunology

LAB Laboratory

MB Microbiology

MCB Mycobacteriology

MYC Mycology

NMS Nuclear medicine scan

NMR Nuclear magnetic resonance

NRS Nursing service measures

OUS OB Ultrasound

OT Occupational Therapy

OTH Other

OSL Outside Lab

PAR Parasitology

PAT Pathology (gross & histopath, not surgical)

PHR Pharmacy

PT Physical Therapy

PHY Physician (Hx. Dx, admission note, etc.)

PF Pulmonary function

RAD Radiology

RX Radiograph

RUS Radiology ultrasound

RC Respiratory Care (therapy)

RT Radiation therapy

SR Serology

SP Surgical Pathology

TX Toxicology

URN Urinalysis

VUS Vascular Ultrasound

VR Virology

XRC Cineradiograph

HL7 Table 0123 - Result status

Value Description

O Order received; specimen not yet received

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Value Description

I No results available; specimen received, procedure incomplete

S No results available; procedure scheduled, but not done

A Some, but not all, results available

P Preliminary: A verified early result is available, final results not yet obtained

C Correction to results

R Results stored; not yet verified

F Final results; results stored and verified. Can only be changed with a corrected result.

X No results available; Order canceled.

Y No order on record for this test. (Used only on queries)

Z No record of this patient. (Used only on queries)

HL7 Table 0085 - Observation result status codes interpretation

Value Description

C Record coming over is a correction and thus replaces a final result

D Deletes the OBX record

F Final results; Can only be changed with a corrected result.

I Specimen in lab; results pending

N Not asked; used to affirmatively document that the observation identified in the OBX was not sought
when the universal service ID in OBR-4 implies that it would be sought.

O Order detail description only (no result)

P Preliminary results

R Results entered -- not verified

S Partial results

X Results cannot be obtained for this observation

U Results status change to final without retransmitting results already sent as ‘preliminary.’ E.g.,
radiology changes status from preliminary to final

W Post original as wrong, e.g., transmitted for wrong patient

HL7 Table 0119 – Order Control Codes

Value Description

AF Order/service refill request approval

CA Cancel order/service request

CH Child order/service

CN Combined result

CR Canceled as requested

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Value Description

DC Discontinue order/service request

DE Data errors

DF Order/service refill request denied

DR Discontinued as requested

FU Order/service refilled, unsolicited

HD Hold order request

HR On hold as requested

LI Link order/service to patient care problem or goal

NA Number assigned

NW New order/service

OC Order/service canceled

OD Order/service discontinued

OE Order/service released

OF Order/service refilled as requested

OH Order/service held

OK Order/service accepted & OK

OP Notification of order for outside dispense

OR Released as requested

PA Parent order/service

PR Previous Results with new order/service

PY Notification of replacement order for outside dispense

RE Observations/Performed Service to follow

RF Refill order/service request

RL Release previous hold

RO Replacement order

RP Order/service replace request

RQ Replaced as requested

RR Request received

RU Replaced unsolicited

SC Status changed

SN Send order/service number

SR Response to send order/service status request

SS Send order/service status request

UA Unable to accept order/service

UC Unable to cancel

UD Unable to discontinue

UF Unable to refill

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Value Description

UH Unable to put on hold

UM Unable to replace

UN Unlink order/service from patient care problem or goal

UR Unable to release

UX Unable to change

XO Change order/service request

XR Changed as requested

XX Order/service changed, unsol.

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